The Institute of Health Information and Statistics of the Czech Republic,
Czech Society for Oncology, Czech Medical Association of J.E. Purkyně
“Expensive healthcare does not always mean the best healthcare”, says the latest edition of Health at a Glance, which is issued by the Organisation for Economic Co-operation and Development (OECD). Based on statistical data, this publication demonstrates that there are differences in the quality of healthcare between the individual countries and none of the countries provides high quality care in all areas. Hence, every country has room to improve the functioning of its healthcare system, and greater financial resources are not always necessary for this purpose.
Published results suggest an improvement in the treatment of severe health problems, such as malignant neoplasms or stroke. At the same time, it is evident that the treatment of certain chronic diseases, such as asthma and diabetes, lags behind good practice in many countries, thus leading to the impaired health of the population and subsequent increases in healthcare costs.
The publication further presents data on the state of health and its non-healthcare determinants, healthcare professionals, healthcare capacities and activities, access to medical care and healthcare costs and financing.
What is the quality of healthcare in the Czech Republic?
On a long-term basis, the mortality rate for malignant neoplasms in the Czech Republic is one of the highest among the OECD countries, which is caused, among other things, by the fact that we are among the populations with the highest oncology burden in Europe. According to results presented in the OECD publication, this applies to the five-year relative survival rate in selected malignant neoplasms (breast cancer, cervical cancer and colorectal cancer). In this respect, the Czech Republics position seems the to be below average at first glance, nevertheless it is apparent from the data that the survival rate in the Czech Republic for the last 15 years increased very considerably in all three diagnoses studied. This improvement can be further observed in the latest data for the Czech Republic, which were however not used in the publication due to the reason of comparability with other countries.
When evaluating the summarily calculated patient survival, we should think about what these results show. First of all, it should be noted that many countries with a similarly high mortality rate to that of the Czech Republic are not included in the OECD publication. Therefore, the relative five-year survival cannot be considered as a direct indicator of the quality of cancer treatment. Rather, it is an indicator of the overall epidemiological situation that includes various aspects, including early detection of malignant neoplasms and overall functionality of the healthcare system in the given country.
The calculation of survival rate itself takes into account a different age structure of various populations but it doesnt reflect the clinical stages that are known to substantially determine the possibilities of treatment and survival.
It is not a coincidence that the selected three cancer diagnoses are preventable, and can be effectively screened in the population and diagnosed early with the help of screening programmes. And it is also not a coincidence that the worst survival results in the Czech Republic are those for colorectal cancer. This is caused by the bleak fact that more than 50% of patients with this diagnosis in the Czech Republic are diagnosed while in an advanced clinical stage, which means a stage when the chance of long-term survival is markedly reduced. A high percentage of late detected tumours thus reduces the overall results of the treatment compared to many other countries.
In this respect, it is very important to focus more intensively on early detection of malignant neoplasms in the Czech Republic. This could be done by a strengthening of preventive screening programmes, and at present mammography screening programmes (prevention of breast cancer), cervical screening (prevention of cervical cancer) and colorectal screening (prevention of colorectal cancer) are ongoing in the Czech Republic. In this area, the Czech Republic lags behind many developed countries, although the situation has markedly improved in recent years. We have, of course, a lot of things to be improved in the diagnosis of colorectal cancer and also cervical cancer. In contrast, the increasing strength and impact of breast screening, which exceeded 50% population coverage in the year 2008 and contributes to an improvement in the survival of breast cancer patients, is a great success. In this respect, data from breast screening in the year 2006 shown in the OECD publication is no longer current (but had to be used for the purpose of comparability with other countries) and reflects the situation in which the screening did not express todays parameters.
It is obvious that citizens themselves have to contribute by their participation in the preventive programmes in order to improve the dismal values, especially in colorectal cancer. When planning and implementing preventive programmes, it is important to ensure the involvement of the widest population, including socially or otherwise handicapped individuals, which are generally reported to have a lower involvement in these programmes, as suggested by the results of the study described in the chapter regarding access to medical care. Special portals guaranteed by scientific/professional organisations are available in the Czech Republic to inform about the background, condition, and availability of screening programmes for malignant neoplasms in the Czech Republic, such as: www.mamo.cz, www.cervix.cz, and www.kolorektum.cz.
The cancer data presented undoubtedly reveal that the Czech Republic is experiencing a significant improvement of survival rates among patients with malignant neoplasms. If we are able to strengthen the screening programmes and people take part in them, this positive trend will continue.
Other results in the area of healthcare quality suggest that hospital mortality within 30 days after acute myocardial infarction and stroke is mildly worse in the Czech Republic than the average for OECD countries. On a long-term basis, the Czech Republic is among countries with a high vaccination rate of children against serious infectious diseases. On the other hand, we are among countries with the lowest percentage of elderly vaccinated against influenza, although this situation has also been mildly improving.
For more information see: www.oecd.org/health/healthataglance.